Telecare “enabled” - The future of assistive technology in
commissioning services for people
Jeremy PorteusHousing Network Lead
Change Agent Team
22 February 2005
Designing for Life
Telecare• Included in DH ICES guidance (March 2001)• Telecare Advisory Group and pilot project (2003)• Telecare ‘Getting Started pack’ (revised 2005)• Audit Commission report (Feb 2004)• ICES/Audit Commission/CAT Conferences
(Summer 2004)• DH Green Paper (expected February 2005)• DH Policy Collaborative till March 2005• £80m in Spending Review from 2006
Understanding the language• Assistive Technology: Any equipment or system that assists people who
have difficulties due to age or disability in carrying out everyday activities (source R Curry) or a product or service that enables independence for older and disabled people (source: FAST)
• Telecare: the remote or enhanced delivery of health and social services to people in their own home by means of communications and computerised systems (source: Barnes)
• Telemedicine: the practice of medical care using interactive audio-visual and data communications – this includes the delivery of medical care, diagnosis, consultation and treatment, as well as health education and the transfer of medical data (source: WHO)
• Smart House: A dwelling incorporating a communication network that connects the key electrical appliances and services, and allows them to be remotely controlled, monitored or accesssed (source: Housing LIN factsheet)
•
Information & communication, e.g.health advice, triage, access to self-help groups
Safety and security monitoring, e.g. Bath overflowing, gas left on, door unlocked
Personal monitoring:•Physiological signs•Activities of daily living
Electronic assistive technology, e.g. environmental controls, doors opening/closing, control of beds
Improving functionality
Mitigating risk
The individual in their home or wider environment
Features of a Telecare ServiceFeatures of a Telecare Service
Implementing Telecare• Over 1.4 million users of community alarms in the UK• 150 social services departments, 303 PCTs, 238
district councils, housing associations, alarm service/ independent providers, demonstration facilities
• 138 community equipment services – health/social services (some housing/education links) majority with S31 agreements and pooled funds, single point of contact, equipment tracking, some contracted services etc
• Seven day delivery for most equipment incl telecare (PAF indicator)
• Various forms of funding to date, mostly pilots/projects, £80m for 2006-2008
• Policy Collaborative, Getting Started Pack
Background to Telecare• Community alarms emerged from concern about
isolated older people and availability of cheap technology in 60’s and 70’s
• Driven by local authorities and more recently housing associations
• Were strongly associated with social rented and sheltered housing
• However, there have been huge technological advances – new products, new wireless technologies, assistive technology
• Huge social change too and different ways of considering customer and commissioners’ needs
A case for improved
integrated working
We are sometimes the wrong services providing the wrong service at the
wrong time
We need to review how and where we spend
resouces
The rate of change in health care must link to change in
social care & housing provision
The key providers must coordinate their services
more effectively
We are still driving a reactive approach to care
and housing
We need to develop enhanced preventative
services
33% increase in people needing care in next 10 years
Demand is increasing more quickly than ever before
Not developing the types of care services needed in
the future fast enough
We are far to slow
Govt will no longer tolerate poor performance or slow progress
Cash rewards are available to those willing to change
Low overall expectation
User expectations will increase in both needs and
wants
Assessment including telecare
• Fair Access to Care Services (FACS) – Critical, Substantial, Moderate, Low Risk
• Single Assessment Process (SAP) – assessment tools – Contact, Overview, Specialist, Comprehensive
• Supporting People Support Plans?
• Financial assessment – if charging for services
• Self-assessment
• Direct payment options – social care assessment
• Self-purchase
Telecare and hospital admissions
• Telecare has a potential role in avoiding hospital admissions as well as supporting discharges
• For preventive and admission avoidance approaches you will need to look at the models of supporting long term conditions (eg heart failure, strokes) where there are multiple admissions
• For hospital discharge approaches, you will need to look at intermediate care, step-up/down facilities, extra care housing, link with home improvement or Care & Repair agencies etc
• Reducing unnecessary hospital admissions will maintain independence for users/carers and stabilise costs particularly under the national tariff from April 2005
Making the business case for telecare
• Empowerment of service users – better involvement in the management of health and lifestyle conditions
• Better us of staff time – responding to specific needs, alerts and circumstances in the home
• Quicker diagnosis and referral for care, treatment or other service
• A significant health dividend – prevention, and reduction of hospital admission or home from hospital care
• Support and manage independence in the home• The glue to a coordinated approach to support people
at home
User at home
Heart Disease
Stroke
Falls
COPD
Cancer
MND, MS Long term
conds
Major Phys Dis
Loneliness/ isolation
Dementia
Sensory/ com loss
Ageing/ Senility
Other Phys Dis
LD/MH
Care pathway
Temp Phys Dis
Housing
Integrated services to support independence
Care pathway
Wandering?
Lives alone?
Yes
Yes
Yes
>1 fall per month?
FallsIsolated/lonely
Demetia
3 or more admissions?
FACS
Critical?
Substantial?
Moderate?
Yes
Yes
Yes
No
No
No
No
Yes
SAP
Contact?
Overview?
Specialist?
Yes
Yes
Yes
No
No
No
No
Yes
Comprehen-sive?
Services
Case Management
Nursing/ home care/ specialist dementia care & support
Int care/rehab
Telecare/ telehealth – falls monitor, reminders, wandering, bed occupancy etc
Housing
Low?
Assessment
Specific needsMICRO
MACROGeneral needs
Moving on Staying put
Technology
HomeCare
Acute sector
Primary care
Domiciliary/homecare
Residential/nursingcare
Communityhousing
Ageing-in-place
Sheltered and verysheltered (ECH)
Adapted housing
Aids, adaptationsand equipment
•Eneabling Technology Technology•EEnabling Technology
Telecare – the challenge• No mainstream telecare in England yet, no joint
commissioning -Telecare not provided as a ‘care option’, what happens with practice-based commissioning?
• Single assessment still a vision rather than a reality in many areas – telecare not in CSR
• 150 SSDs, 303 PCTs, 238 DCs, housing assns, alarm providers would need to be involved in assessment and care planning via SAP/FACS etc with information sharing
• Impact of Supporting People reviews?• Some processes could be lengthy – project manager, ethics,
charging, procurement, agreements, training, information-sharing protocols etc – need to start NOW
• Lack of clarity over what ‘assessed needs’ to address with telecare – do we have the evidence? High or low FACS?
Telecare checklist
• The patient or client group to be supported• The care process to be enhanced through telecare• The care setting• The scale of the proposed service (the number of patients or clients
served)• The scope of the proposed service (the functionality of the service)• The referral process into the service• The equipment installation, maintenance and monitoring service• The response service• The fit with existing care teams• The capacity of existing care teams to provide the response• The training needs of new and existing staff • The distribution of costs and benefits amongst stakeholders• The role of private sector suppliers
Further information
• Housing LIN, Change Agent Team - www.changeagentteam.org.uk/housing
• Audit Commission - http://www.audit-commission.gov.uk
• ICES Team – www.icesdoh.org • Telecare pack - www.icesdoh.org/telecare • Policy Collaborative: http://
www.info.doh.gov.uk/etpc/etpc.nsf
Future perfect?